Coffee & Surprises

I was reading the newspaper this morning when I stumbled onto an engagement announcement that made me almost spit my coffee out. The guy I used to date in high school is now engaged. In all honesty, I always knew one Sunday I'd read this in the paper. And, I actually also thought it would be a smack in the face. Today, I almost spit my coffee out from snickering - not from shock. My oh my how time changes people. He went from the guy who lifted weights for 3 hours every evening to the guy who apparently has been eating donuts for 3 hours every night. I also couldn't help but notice that his hair is fading away. He's going bald at 25. Holy crap. I asked a fellow high school classmate if he thought my ex's egotisitical attitude faded away with his hair. My classmates reply - "I highly doubt it." Seeing the engagment didn't hurt - it actually made me proud about where I am in life. :)

Here's to the guy who told me I needed to lose weight - the guy who got pissed off when the Alzheimer's patients beat him at Yahtzee - the guy who would pout when I outwitted him - the guy who told me he couldn't see me anymore because I was too emotional over my Nan dying - I guess eventually we all get what is ours. :) I'd say he got his in SPADES. Teehee.

Staff Encounters of the Third Kind

Sunday was by far the most adventurous day of staffing I have experienced thus far. I would describe myself as very orderly - very neat. Actually, I'm just this side of OCD. My colleague this weekend...I'm surprised he could even find his keyboard under the multitude of paperwork he had stacked up. When I came on shift at 8:00am, he hadn't even given the midnight pharmacist his break. The tech was up to her eyeballs with IVs in the IV room. And my colleague...he was updating compounding binders in the IV room. I agree this is a task that needs to be done....but does it really need to be done when there are 110 IVs to be compounded??? The midnight pharmacist agreed to hold down the input station until I got our tech caught up in the IV room. 45 minutes later, my colleague was still updating binders. The tech was left with 20 or so IVs to compound, so I went out and let the midnight pharmacist go to lunch. The morning progressed pretty much like this - I inputted the inpatient orders, I processed the discharges, I filled the Pyxis in the ICU, I filled the narcotics for the ER...basically I ran my ass off. Meanwhile, my colleague picked his nose and checked his stocks. We had a guy in the ICU using a tubex of fentanyl every hour, so we suggested changing him to a fentanyl drip. Every fentanyl drip I have ever made or seen hanging in the ICU is 500mcg fentanyl in 500mL NS. My illustrious colleague wanted to make it 2500mcg fentanyl in 250mL NS. I highly advised him against this. The nurses up there are accustomed to 1:1 dilutions. If they need 10mcg of fentanyl, they give 10mL of the drip. This was setting him up for a major drug error. I also informed him that each tubex was 100mcg/2mL. I highly doubted the 250mL piggy of NS could hold 50mL more of fluid. He looked at me like I was from outer space. I informed him that I was going to have NOTHING to do with the drip. I didn't want my name on it at all. It took him 1.5 hours to calculate the drip out and compound it. (Yes I said 1.5 hours - meanwhile the freaking ICU was pushing 75mcg of fentanyl every hour and bolusing him with 150mcg of fentanyl!!!) Well - after he got the fentanyl out of our narcotic vault, he decided to set the alarm...and not lock the door. I got an ER call for codeine cough syrup. I went up to outpatient, scanned my badge, and entered the pharmacy. By the time I made it to the vault, there was a piercing beeping sound. This was followed 10 seconds later by a loud beating on the pickup window. I pulled up the blinds to find a federal police officer. By the look on his face, he was really concerned about my safety. He wouldn't believe me that I was ok. I finally let him in the pharmacy. After walking around and ensuring there weren't any veterans hiding in the aisles, he bid me a good day. I called my colleague and thanked him for allowing me the experience to meet our lovely police force. He thought it was funny. I think he's an idiot! HA! When the evening pharmacist came on shift - he asked what my colleague had done all day because by this time, his stack of paper covered his keyboard and his chair. I just rolled my eyes. The evening shift told me to go home - I had earned my keep for one day. HA! Oh yea, did I mention that my colleague has been a pharmacist at the hospital for over 20 years??? Yea...ridiculous!

Everybody's Working for the Weekend

...ok, it's just me working for the weekend. What can I say, misery loves company. :) Actually today wasn't too bad. I managed to stay busy most of the day. The ice brought lots of injuries to the ER, so I spent most of the afternoon on the phone with the nurses and docs in the ER getting prescriptions. Hopefully tomorrow will fly by as well.

This evening I was flipping through the channels when I landed on CSPAN and found Senator Byrd passionately addressing the Senate. I sat in awe as I watched him shake his hand and raise his voice. When I attended the Jefferson-Jackson dinner this past October, I was very concerned about his health. However, any reservations I had about his ability to fight the good fight were set aside after I watched him today. He spoke passionately. He waved his hands and stomped his feet. He wants our men and women in uniform home as much as I do. He helped condemn the Republican view that "you can't support our troops and not support the war." I really think the men and women who served in Iraq should be voting on whether we send another 20,000 troops to Iraq. This really shouldn't be a Republican/Democrat matter - but more of a humanity matter. It breaks my heart to see our boys come home broken, shattered - shells of human beings. Those that survive are maimed for life - phsycially, psychologically, and emotionally. This war is the tragedy of my life time. America spoke loud and clear in November, and it's high time the government starts listening. We don't want to send 20,000 more troops - we don't want to send ANY more troops. We want our boys home and we want them home now. Thank you Senator Byrd for hearing us - and for always fighting the good fight.

Overwhelmed - Party of 1

Ok - I am officially feeling a little overwhelmed. So far this year, I've been able to juggle work, personal life, projects, and life in general. Now...I'm dropping things on my head. I'm barely treading water here! Case in point - I initiated the institutional review board paperwork for my project in October (October, as in 4 months ago). Today I received an email informing me that my presence was requested in Gainesville, Florida this Friday because I am doing a research project and I needed some kind of training. Ok - first of all what kind of notification is 2 days - especially when it would require PLANE tickets to get to Gainesville??? So, I forwarded the email to the R&D director at DC. Instead of answering my question, she sent me another email telling me that my presence was requested in DC next Tuesday from 12-1. It will take me more time to drive to DC than I will be spending in DC. WTF? Oh, yea add to this that the co-investigator in my project is in Arizona (and will still be there next Tuesday) AND that we're interviewing a candidate for one of our residency slots on that very day. She happens to be coming from Florida - and that requires plane tickets - which are usually non-refundable. Again, I was given 1 week notice to this freaking "requirement" - and was only notified when I asked if I should be running to the travel office at my VA to get plane tickets to Florida! Honestly! The IRB can kiss my ass at this point. It was my understanding that this interaction was supposed to foster future research on my part - HA! I can tell you it will be a cold day in Hell before I do ANY more research.

On a sad note, my very first Zebra pen - the one I got after my first weekend staffing - died today while I was interviewing a patient. I even took it apart to make sure it was out of ink...and dammit it was. I almost cried. And then I panicked because I haven't wrote with any pen except for a Zebra for 7 months. I came damn close to a panic attack. I located a Government Issue Stanford, which is not nearly as nice as my Zebra, but sufficed.

Let's see here's the list of shit for the rest of the week:
1) Have conversion plan for fentanyl patches in place by tomorrow at 1500
2) Present said plan to primary care Thursday
3) Tweak fentanyl MUE to suggestions from primary care
4) Tour P3 students around my facility and tell them how rewarding residency is
5) Present journal club on varenicline Thursday at lunch
6) Research Factor II deficiency as it relates to colon cancer
7) Compare and contrast University of Washington, Circulation, and CHEST guidelines for warfarin
8) Attend waste-of-my-friggin'-time residency meeting at Snot U on Friday
9) Staff this weekend
10) Figure out what the hell I'm supposed to do next week

Song of the week - "Face Down" by The Red Jumpsuit Apparatus

Week from Hell

I typically rate how bad my day was by what time I walk to my car. It's a bad day if it's post-4:30 when I trudge out in the cold. It's great day if I'm in the car with the heat blasting at 4:30. This past week, I didn't walk to my car prior to 5:00 one freaking day. What a kick in the pants. Honestly, working in the clinic has been more hectic than working in the ICU. I started in the anti-coagulation clinic this past Monday. It's very busy. And I really don't think it's the patients - it's the multitude of questions I get on an hourly basis. Add to that my other responsibilities as a resident - and I'm spread a little thin right now. Needless to say, I've restarted my rantidine therapy. I used to take omeprazole, but found that to be a little pricey, so I've initiated ranitidine therapy which is significantly cheaper and just as effective. My love life is still a little in shambles. Fireman is still there on the edges of my life - calling me at 12:30AM, sending me text messages, asking me to give him a second chance. Then there's Rx. He's got me intrigued...and he's got an undetermined status. WTF? I guess he didn't say "NO!" I'm trying to remain positive and not run from that situation. Patience and time is what I need - neither of which am I good at. I guess I don't have much choice here...just sit and wait.

On the positive side - I'm so excited to say that I now weigh less than I did my junior and senior years in high school. **Dancing around** My BMI is 20.9, and my weight is 122. I'm very proud of myself. :) I bought a new suit yesterday. I'm presenting my research project in Baltimore in May. My current suit falls off my hips. I slipped into a size that I haven't worn since I was a freshman in high school. Woohoo!!!! :)

Dr. Ahsirt - ICU Attending

Yesterday marked the final day of my ICU rotation. I entered the ICU to find that we were doctorless. Apparently the new attending required a mental health day following the week from hell, and all of the other physicians were scheduled off. After deciding that the ICU would not run on auto-pilot, they decided to contact the Chief of Medicine...who also had taken a vacation day. It was at this point that they all recognized my presence in the ICU. They took a vote and I was unanimously nominated to be the ICU attending yesterday. I had their full vote of confidence. One of them even said that I would probably do a better job than those trained to be there. HA! I informed that while I could round on the patients, I would not be able to write orders. At this point the administrative assistant looked up and told me that if I would write the orders, she would find someone to sign them. I hung out with the nurses most of the morning. They eventually got an attending around lunch time. I was in the process of planning on how to extubate the Green Beret when the pulmonologist showed up. I didn't want to step on anyone's toes, so I relinquished the extubation to him. *snicker* I returned to the dungeon in the basement after being bid farewell by everyone in ICU. Apparently, my presence will be greatly missed.

The tear jearker moment of the day happened at 2:45pm. Dr. M, the pulmonologist, paged me. I returned his call and he asked me to come to the ICU. When I got there, he stood and expressed his most heart felt condolences to the entire pharmacy team for our loss. He wanted me to know that he was with Marilyn the entire time, and that they did every thing in their power to save her. It got me a little choked up. He then told me that he was very sorry that he would not be able to work with me as I furthered my career in pharmacy. He told me that I was going to do great things. That also got me a little choked up. The nurses thanked me for all of my help. Then Dr. Mallea asked me for help using a dosing nomogram for one of his patients. The nurses informed me that they would not hang the drug until I gave it my blessing. It was very rewarding. I'm going to miss it immensely.

Black Day at the VA

Today was a very sad day at the VA. Marilyn, one of our inpatient technicians, passed away today. While preparing for a retirement party for another technician, she collapsed in our inpatient pharmacy. The fire department on station was called and they transported her to the ER. I was told they worked on her for 20 minutes before pronouncing her. When I got the pharmacy, our director was returning from the ER with her badge and personal effects. It was quite an emotional time.